The Cardiorenal Syndrome: Mechanistic Insights and Prognostication with Soluble Biomarkers
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CARDIAC BIOMARKERS (CR DEFILIPPI, SECTION EDITOR)
The Cardiorenal Syndrome: Mechanistic Insights and Prognostication with Soluble Biomarkers Stephen Seliger 1
# Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Purpose of Review To characterize and interpret recent studies of biomarkers of cardiorenal syndrome. Recent Findings Recent studies have questioned the mechanisms and significance of moderate worsening renal function (WRF) in patients with acute heart failure. In the setting of successful decongestion, WRF may not predict cardiorenal morbidity. Cardiac-specific biomarkers including cardiac troponins and natriuretic peptides are highly prognostic in acute and chronic HF patients with kidney impairment, and serial changes in these markers during hospitalization are also predictive of longerterm adverse outcomes. These markers also predict new HF in patients with established chronic kidney disease (CKD). The role of kidney tubular injury markers in acute HF remains controversial, with inconsistent associations with short- and long-term cardiorenal outcomes. Many cases of WRF in acute HF are not characterized by a clear pattern of renal tubular injury. Summary Cardiac-specific and renal-specific biomarkers may provide mechanistic and prognostic information in cardiorenal syndromes. Keywords Heart failure . Biomarkers . Kidney disease . Cardiorenal syndrome . Epidemiology
Introduction The complex interactions between the kidneys and cardiovascular dysfunction were first systematically characterized by the NHLBI Working Group on “cardiorenal interactions in heart failure and cardiovascular disease” in 2004. Subsequently, in 2008, a workgroup from the Acute Dialysis Quality Initiative (ADQI) developed a consensus report on cardiorenal syndromes (CRS), [1] which defined five types of CRS, explicitly distinguishing acute vs. chronic syndromes, and those syndromes in which cardiac vs. renal dysfunction was attributed as the initial insult (Table 1). These subcategories of syndromes were developed along conceptual models of pathophysiology, rather than based on clear distinct diagnostic criteria. Each subcategory incorporates an initial insult to organ function (cardiorenal or reno-cardiac) but hypothesizes bidirectional secondary effects which perpetuate organ This article is part of the Topical Collection on Cardiac Biomarkers * Stephen Seliger [email protected] 1
University of Maryland School of Medicine, 22 S. Greene Street N3W143, Baltimore, MD 21201, USA
dysfunction in a vicious cycle. In clinical practice, it may be difficult to identify the primary insult when patients present with both cardiac and renal functional impairment simultaneously. This bidirectionality also has important implications for the study of mechanistic and prognostic biomarkers in CRS. This review will focus primarily on recent research of biomarkers and mechanisms in types 1 and 2 CRS, although many of the studies discussed have implications for renocardiac syndromes as well.
Mechanisms of Renal I
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